Overview of GERD
Gastro-esophageal reflux disease affects 20-30% of the population in western countries. The US has one of the highest rates of GERD, which is largely due to factors such as diet, exposure to toxins (being a highly industrialized nation), stressful lifestyles, decreased sleep patterns and work being dominated by desk jobs rather than manual jobs. While older people are more likely to have more severe GERD symptoms, GERD can affect the young population as well.
The reduction of gastric acid production slows down the production of protective mucosal membranes that line the sinus cavities, mouth, throat, airways and GI tract. Gastric acid inhibitors change enzyme secretions and alter human adaptability to different foods, which opens the door to intestinal permeability, autoimmune disease and food allergies.
Physiology of GERD
GERD is not simply acids leaking into the lower esophagus. This condition occurs in situations of both increased and decreased stomach acid. The factors that operate to give rise to GERD include:
- Weakening of the lower esophageal sphincter, a situation mediated through cholecystokinin receptors (CCK- A)
- Anatomical distortion, which may weaken the sphincter when paired with hiatal hernia
- Overgrowth of H pylori, which reduces acid, causes inflammation and results in decreased protective mucus and enzyme production
The Mucosal Connection
GERD is a result of inflammation, causing defective or weakened mucosal membranes. Apart from actual damage to the epithelial cells, the lack of mucus secretion augments the damage to mucosal membranes. This results in the loss of its protective effect on the surfaces of various organs, like the esophagus, thereby increasing the damaging effect of acid, pathogenic bacteria and toxins.
Within this mucous membrane there are other factors which provide protection such as probiotics, immunoglobulins, antioxidants and white cells. These mucosal membranes also provide epithelial cleansing, such as removal of dead bacteria, virus pieces and toxin portions. Lastly, the mucous membranes transport corticosteroids to the epithelial tissues to squelch inflammatory responses within the epithelial tissues.
This nullifying of the inflammatory response is also mediated by certain essential fatty acids through inhibition of cyclooxygenase enzyme inhibition (COX) and arachidonate-5-lipooxygenase (5-LOX) enzyme. The COX-1 enzyme instigates Prostaglandin 2 which is anti-inflammatory, and COX-2 instigates the process of inflammation through prostaglandin 12 (PG 12). Since this conversion is dependent upon which fatty acid is ingested, the inflammatory process can be buffered (Alpha-linolenic acid – Omega-3 Fatty Acids ALA ,DHA, EPA and Omega-6 Fatty acid GLA).Back to Top
- Daily or, rarely, weekly heartburn
- Voice box changes due to affection of the vocal cords by the reflux
- Dental erosion
- Cystic fibrosis
- Multiple sclerosis
- Esophageal cancer
- Irritable bowel syndrome
GERD may occur in association with other conditions such as:
- Lung and congestive ailments
- Airway conditions—asthma, chronic sinusitis and esophagitis
- Infection by Helicobacter pylori
- Gallbladder dysfunction
- Hiatal hernia
- Due to lack of hydrochloric acid, certain mineral absorption is affected, such as magnesium (constipation, restless legs syndrome, higher levels of anxiety, atrial fibrillation); calcium (osteoporosis, osteopenia and increased hip fracture incidence; and iron (anemia).
- Recent reports indicate an increased incidence of Clostridium difficile infections as well as E.coli, salmonella , cholera and other dangerous bugs in the gastrointestinal tract.
Management of GERD
The correction of GERD is possible. Part of the successful treatment of GERD necessitates factoring these “other” factors into the corrective treatment strategies.
The “quick” fixes are often associated with significant negative consequences. At least 10% of GERD sufferers have low gastric acid, which can be easily tested for. The medications listed below reduce stomach acid but produce no relief for GERD.
- Antacids: Antacids cause the stomach’s strong barrier to erode. Antacids erode the stomach’s protective barrier, affecting the mucosal health of both the esophagus and the stomach.
- Calcium salts: These usually neutralize acids and, therefore, have the same effect as antacids. They can also produce constipation and diarrhea, as well as hypercalcemia.
- Aluminum salts (Mylanta, Amphogel and Maalox): Aluminum depletes calcium stores in the body. Aluminum hydroxide can produce renal failure and aluminum can deposit in bones and joints. Aluminum is found in the brains of dementia patients.
- Bismuth salts (Pepto-Bismol): These inhibit acid and enzyme production, thereby interfering with digestion.
- Proton-Pump Inhibitors (PPIs): These reduce the acidity but not the frequency of reflux episodes. They may result in suffering more nighttime reflux episodes than if they were not being taken.
Long Term Fixes
- Correction of lifestyle: Decreasing stress, improving diet, eliminating toxins, insuring adequate hydration, avoiding foods that irritate, avoiding alcohol and smoking
- Probiotics (oral and distal GI tract probiotics): Daily flossing, tongue scraping, frequent plaque removal, non-toxic mouthwash (preferably derived from essential oils) help decrease passage of harmful bacteria from mouth to stomach
- Ensure adequate sleep, since lack of sleep results in increase stress to the body.
- Exclude harmful microorganisms such as viruses, fungi, yeasts, mold and chronic bacterial infections such as Lyme.
These usually work at multiple levels:
- Reducing inflammation
- Increasing mucus secretion
- Restoring the integrity of the epithelial cells
- Improving gall bladder and liver function
- Having a mucilage effect
- Supplying antioxidants
- Antispasmodic effects
- Strengthen the circulation
- Some herbs inhibit the growth of H. pylori
These include certain vitamins and supplements, as well as minerals. Antioxidants are usually encouraged in food-form; however, there are many reputable companies that produce these supplements in liquid, capsule, powder or tablet form.
Testing for GERD
Gastro-esophageal reflux is difficult to diagnose. However, there are numerous ways to test for it, including a physical examination and tests that include scintigrams, laryngoscopy, gastrointestinal studies, esophageal pH monitoring and esophagoduodenoscopy with a biopsy. These tests allow us to sample mucus and tissues of the esophagus and analyze the health and tone of esophageal sphincters.
There are even more sophisticated tests that can be utilized, specifically an electronic capsule that, when swallowed, emits radiofrequency waves. Measurements are made before and after the administration of sodium bicarbonate, which indicates the functionality of the acid-producing cells in the stomach.
At Houston Wellness Clinic, we can provide dietary advice, lifestyle changes, avoidance and elimination of toxins and a treatment schedule. This treatment schedule would include herbs are most helpful for GERD, the best antioxidants, steps to decrease stress and natural adjuncts for reducing obesity. We can provide the best probiotics for GERD, and a treatment schedule to improve gallbladder and liver function. Many of these corrective measures can be achieved by eating the correct foods.Contact Dr. Allibone today >> Back to Top
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